Blood Transfusion Practices in Dengue Fever: A Cross Sectional Single Center Study During a Dengue Outbreak in Pakistan

Abstract

Introduction: Dengue fever (DF) is a global health problem in tropical and subtropical regions across the globe. Pakistan has become one of the countries which are hit by its outbreaks for the past two decades with the first outbreak reported in 1994.It is a mosquito-borne infection which is transmitted to humans from the mosquito bite. Characteristics of dengue fever are thrombocytopenia, coagulopathy and increased capillary permeability. The disease spectrum ranges from mild fever to life threatening hemorrhagic shock syndrome; hemorrhagic manifestations are the most feared complications of the disease. Guidelines regarding fluid management in dengue fever have been established by Center for Disease Control (CDC) and local national bodies in Pakistan however comprehensive data regarding blood product usage is lacking. Understanding the rationale use of blood products can reduce burden on blood bank inventories as well as reduce unnecessary blood product exposure to the patients in dengue outbreak.

Aims & Objectives: Assessment of compliance of physicians and transfusion provision authorities regarding blood products usage with local and international guidelines in managing dengue outbreak.

Place and duration of study: This study was conducted at Chughtai Institute of Pathology, Lahore from September 2021 to November 2021.

Material & Methods: It was a cross sectional study. Total 107 patients who were non-structural antigen1(NS1) positive confirmed dengue infection presented at Chughtai Blood Bank for request of any blood product were included in the study; individuals with existing cytopenia (known cases) unrelated to Dengue (NS1 antigen positive) were excluded. Data was recorded on a pre-designed Performa/questionnaire. Statistical analysis was performed using SPSS 23.0. Frequencies were calculated and expressed as percentages.

Results: Mean Age of 107 patients was 53 years (±19.05) out of which 63(58.9%) were males and 44(41.1%) were females. Blood products requested were platelets in 93(86.9%) patients, platelets and fresh frozen plasma in 3(2.8%), platelets and whole blood in 9(8.4%) and whole blood in 2(1.9%) patients. Therapeutic platelet transfusions were done in 35(32.7%) patients and prophylactic platelet transfusions were done in 72(67.3%) patients.

Conclusion: Lack of practicing evidence-based guidelines and inappropriate usage of blood products during dengue epidemic overburdens health care facilities and adds to the stress and panic. A well-coordinated centralized management system for dengue outbreak can play pivotal role in guiding rationale use of blood products.